Subgenual cingulate and visual cortex responses to sad faces predict clinical outcome during antidepressant treatment for depression
Subgenual cingulate and visual cortex responses to sad faces predict clinical outcome during antidepressant treatment for depression
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DOI：
10.1016/j.jad.2009.04.031
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发表时间：
2010-01-01
影响因子：
6.6
通讯作者：
Phillips, Mary
中科院分区：
文献类型：
--
作者：
Keedwell, Paul A.;Drapier, Dominique;Phillips, Mary
背景：以往的随访研究表明，抑郁个体对悲伤的面部刺激而不是快乐的刺激的视觉皮质、腹侧扣带回和皮质下反应的增加可能是疾病严重程度的可逆标志。我们假设，这些区域对悲伤刺激的更大反应，而不是快乐的刺激，将预示着更好的后续临床结果。我们还探索了预测不良结果的区域。方法：12名抑郁症患者在二级护理环境中接受抗抑郁药物治疗的早期阶段参与了两项实验，分别使用事件相关功能磁共振技术比较了不同强度的悲伤和快乐面部刺激的反应。在平均延迟12周的治疗后，他们重复了这些实验。结果：治疗的反应有所不同。在治疗的早期阶段，较大的右侧视皮层和右侧膝下扣带回(R-BA25)对悲伤刺激而不是快乐刺激的反应与良好的临床结果相关。限制：样本量适中，患者服用多种抗抑郁药物。结论：在自然主义环境下，对于重度抑郁症的抗抑郁药物治疗中，右侧扣带回和右侧视皮层的反应预示着良好的临床结果。腹外侧额叶皮质活动可能预示着不良预后，因为它与消极的反思冥想有关。(C)2009爱思唯尔B.V.保留所有权利。
Background: Previous follow-up studies indicate that increased visual cortical, ventral cingulate and subcortical responses of depressed individuals to sad facial stimuli, but not happy stimuli could represent reversible markers of disease severity. We hypothesized that greater responses in these areas to sad stimuli, but not happy stimuli, would predict better subsequent clinical outcome. We also explored areas that would predict a poor outcome.Methods: Twelve melancholically depressed individuals in the early stages of antidepressant treatment in a secondary care setting participated in two experiments comparing responses to varying intensities of sad and happy facial stimuli, respectively, using event related functional MRI. They repeated the experiments after a mean delay of 12 weeks of treatment.Results: There was a variation in response to treatment. Greater right visual cortex and right subgenual cingulate (R-BA25) responses to sad stimuli, but not happy stimuli, in the early stages of treatment were associated with a good clinical outcome. Greater ventrolateral prefrontal cortex responses to either stimulus type were associated with a relatively poor outcome.Limitations: The sample size was modest and patients were taking a variety of antidepressants.Conclusions: Right subgenual cingulate and right visual cortical responses to sad stimuli predict good clinical outcome in the context of antidepressant treatment for severe depression in a naturalistic setting. Ventrolateral prefrontal cortex activity may indicate poor prognosis due to its relationship with negative rumination. (C) 2009 Elsevier B.V. All rights reserved.